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Question 1
Correct
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What medication acts as both a serotonin and noradrenaline reuptake inhibitor?
Your Answer: Duloxetine
Explanation:SNRIs include duloxetine and venlafaxine.
Antidepressants: Mechanism of Action
Antidepressants are a class of drugs used to treat depression and other mood disorders. The mechanism of action of antidepressants varies depending on the specific drug. Here are some examples:
Mirtazapine is a noradrenaline and serotonin specific antidepressant (NaSSa). It works by blocking certain receptors in the brain, including 5HT-1, 5HT-2, 5HT-3, and H1 receptors. It also acts as a presynaptic alpha 2 antagonist, which stimulates the release of noradrenaline and serotonin.
Venlafaxine and duloxetine are both serotonin and noradrenaline reuptake inhibitors (SNRIs). They work by blocking the reuptake of these neurotransmitters, which increases their availability in the brain.
Reboxetine is a noradrenaline reuptake inhibitor (NRI). It works by blocking the reuptake of noradrenaline, which increases its availability in the brain.
Bupropion is a noradrenaline and dopamine reuptake inhibitor (NDRI). It works by blocking the reuptake of these neurotransmitters, which increases their availability in the brain.
Trazodone is a weak serotonin reuptake inhibitor (SRI) and 5HT agonist. It works by increasing the availability of serotonin in the brain.
St John’s Wort is a natural supplement that has been used to treat depression. It has a weak monoamine oxidase inhibitor (MAOI) effect and a weak SNRI effect.
In summary, antidepressants work by increasing the availability of certain neurotransmitters in the brain, such as serotonin, noradrenaline, and dopamine. The specific mechanism of action varies depending on the drug.
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This question is part of the following fields:
- Psychopharmacology
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Question 2
Correct
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What category of adverse drug reaction does respiratory depression caused by opioids fall under?
Your Answer: Type A
Explanation:The MHRA categorizes adverse drug reactions into five types. Type A reactions occur when a drug’s usual pharmacological actions are amplified at the normal therapeutic dose, and are typically dose-dependent. Type B reactions are unexpected and not related to the drug’s known pharmacological actions. Type C reactions persist for a prolonged period of time, while Type D reactions become apparent after a delay. Type E reactions are associated with the withdrawal of a medication.
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This question is part of the following fields:
- Psychopharmacology
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Question 3
Correct
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Select the atypical antipsychotic with the shortest half-life.
Your Answer: Quetiapine
Explanation:Due to its short half-life of 6 hours, quetiapine is administered twice daily in divided doses. However, a modified release version called Seroquel XL is available, which can be taken once daily.
Antipsychotic Half-life and Time to Steady State
Antipsychotic medications are commonly used to treat various mental health conditions, including schizophrenia and bipolar disorder. Understanding the half-life and time to steady state of these medications is important for determining dosing and monitoring their effectiveness.
Aripiprazole has a half-life of 75 hours and takes approximately 2 weeks to reach steady state. Olanzapine has a half-life of 30 hours and takes about 1 week to reach steady state. Risperidone has a half-life of 20 hours when taken orally and takes 2-3 days to reach steady state. Clozapine and Amisulpride both have a half-life of 12 hours and take 2-3 days to reach steady state. Ziprasidone has a shorter half-life of 7 hours and takes 2-3 days to reach steady state. Quetiapine has the shortest half-life of 6 hours and also takes 2-3 days to reach steady state.
Knowing the half-life and time to steady state of antipsychotic medications can help healthcare providers determine the appropriate dosing and frequency of administration. It can also aid in monitoring the effectiveness of the medication and adjusting the treatment plan as needed.
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This question is part of the following fields:
- Psychopharmacology
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Question 4
Correct
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Which option is not a treatment for neuroleptic malignant syndrome?
Your Answer: Antipsychotics
Explanation:NMS is a potential side effect of antipsychotics.
Serotonin Syndrome and Neuroleptic Malignant Syndrome are two conditions that can be difficult to differentiate. Serotonin Syndrome is caused by excess serotonergic activity in the CNS and is characterized by neuromuscular abnormalities, altered mental state, and autonomic dysfunction. On the other hand, Neuroleptic Malignant Syndrome is a rare acute disorder of thermoregulation and neuromotor control that is almost exclusively caused by antipsychotics. The symptoms of both syndromes can overlap, but there are some distinguishing clinical features. Hyperreflexia, ocular clonus, and tremors are more prominent in Serotonin Syndrome, while Neuroleptic Malignant Syndrome is characterized by uniform ‘lead-pipe’ rigidity and hyporeflexia. Symptoms of Serotonin Syndrome usually resolve within a few days of stopping the medication, while Neuroleptic Malignant Syndrome can take up to 14 days to remit with appropriate treatment. The following table provides a useful guide to the main differentials of Serotonin Syndrome and Neuroleptic Malignant Syndrome.
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This question is part of the following fields:
- Psychopharmacology
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Question 5
Correct
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What is a significant byproduct of clozapine metabolism?
Your Answer: N-desmethylclozapine
Explanation:Clozapine is an atypical antipsychotic drug that acts as an antagonist at various receptors, including dopamine, histamine, serotonin, adrenergic, and cholinergic receptors. It is mainly metabolized by CYP1A2, and its plasma levels can be affected by inducers and inhibitors of this enzyme. Clozapine is associated with several side effects, including drowsiness, constipation, weight gain, and hypersalivation. Hypersalivation is a paradoxical side effect, and its mechanism is not fully understood, but it may involve clozapine agonist activity at the muscarinic M4 receptor and antagonist activity at the alpha-2 adrenoceptor. Clozapine is also associated with several potentially dangerous adverse events, including agranulocytosis, myocarditis, seizures, severe orthostatic hypotension, increased mortality in elderly patients with dementia-related psychosis, colitis, pancreatitis, thrombocytopenia, thromboembolism, and insulin resistance and diabetes mellitus. The BNF advises caution in using clozapine in patients with prostatic hypertrophy, susceptibility to angle-closure glaucoma, and adults over 60 years. Valproate should be considered when using high doses of clozapine, plasma levels > 0.5 mg/l, of when the patient experiences seizures. Myocarditis is a rare but potentially fatal adverse event associated with clozapine use, and its diagnosis is based on biomarkers and clinical features. The mortality rate of clozapine-induced myocarditis is high, and subsequent use of clozapine in such cases leads to recurrence of myocarditis in most cases.
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This question is part of the following fields:
- Psychopharmacology
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Question 6
Incorrect
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Which of the following is the least probable cause of electroencephalographic alterations?
Your Answer: Risperidone
Correct Answer: Quetiapine
Explanation:Antipsychotics and Their Effects on EEG
The use of antipsychotics has been found to have an impact on the EEG of patients taking them. A study conducted on the subject found that clozapine had the highest percentage of EEG changes at 47.1%, followed by olanzapine at 38.5%, risperidone at 28.0%, and typical antipsychotics at 14.5%. Interestingly, quetiapine did not show any EEG changes in the study. However, another study found that 5% of quetiapine users did experience EEG changes. These findings suggest that antipsychotics can have varying effects on EEG and should be monitored closely in patients taking them.
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This question is part of the following fields:
- Psychopharmacology
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Question 7
Correct
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Which of the following medications has a chemical composition that closely resembles diazepam?
Your Answer: Chlordiazepoxide
Explanation:Chlordiazepoxide belongs to the benzodiazepine class of drugs and shares a similar chemical structure with diazepam.
Clomethiazole is a type of hypnotic that is not classified as a benzodiazepine.
Chloroquine is primarily used as an antimalarial medication.
Chlorphenamine is an antihistamine drug.
Chlorpromazine is classified as a typical antipsychotic medication. -
This question is part of the following fields:
- Psychopharmacology
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Question 8
Correct
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Which drugs have been tested as a treatment for Alzheimer's dementia by targeting amyloid deposition and plaque formation to prevent cognitive decline?
Your Answer: Solanezumab
Explanation:Solanezumab is a type of humanised monoclonal antibody that can bind to the central region of β-amyloid, which is believed to prevent the formation of plaques. However, current research has not yet determined whether this drug is effective in treating Alzheimer’s dementia.
Carbimazole is a medication that is commonly used to treat hyperthyroidism, a condition in which the thyroid gland produces too much thyroid hormone.
Levomilnacipran is a newly approved drug by the FDA that is used to treat major depressive disorder.
Pantoprazole is a type of proton pump inhibitor that is used to treat acid reflux disease, a condition in which stomach acid flows back into the esophagus.
Zubsolv is a recently approved drug by the FDA that is used for the maintenance treatment of opioid dependence.
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This question is part of the following fields:
- Psychopharmacology
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Question 9
Correct
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What is the term used to describe the process of a drug moving from the site of administration to the systemic circulation?
Your Answer: Absorption
Explanation:Pharmacokinetics is the study of how drugs are affected by the body. This includes how drugs are absorbed into the bloodstream, distributed throughout the body, metabolized into different forms, and eliminated from the body. The acronym ADME is often used to remember these processes. Absorption refers to the transportation of the drug from the site of administration to the bloodstream. Hydrophobic drugs are absorbed better than hydrophilic ones. Distribution refers to the movement of the drug from the bloodstream to other areas of the body. Metabolism involves the conversion of the drug into different forms, often to make it more easily excreted by the kidneys. This process occurs in two phases, involving reduction of hydrolysis in phase 1 and conjugation in phase 2. Excretion refers to the elimination of the drug from the body, which mainly occurs through the kidneys and biliary system.
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This question is part of the following fields:
- Psychopharmacology
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Question 10
Incorrect
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What is the most frequently occurring side effect of rivastigmine?
Your Answer: Headache
Correct Answer: Nausea
Explanation:Pharmacological management of dementia involves the use of acetylcholinesterase inhibitors (AChE inhibitors) and memantine. AChE inhibitors prevent the breakdown of acetylcholine, which is deficient in Alzheimer’s due to the loss of cholinergic neurons. Donepezil, galantamine, and rivastigmine are commonly used AChE inhibitors in the management of Alzheimer’s. However, gastrointestinal side effects such as nausea and vomiting are common with these drugs.
Memantine, on the other hand, is an NMDA receptor antagonist that blocks the effects of pathologically elevated levels of glutamate that may lead to neuronal dysfunction. It has a half-life of 60-100 hours and is primarily renally eliminated. Common adverse effects of memantine include somnolence, dizziness, hypertension, dyspnea, constipation, headache, and elevated liver function tests.
Overall, pharmacological management of dementia aims to improve cognitive function and slow down the progression of the disease. However, it is important to note that these drugs do not cure dementia and may only provide temporary relief of symptoms.
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This question is part of the following fields:
- Psychopharmacology
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Question 11
Correct
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Which of the following is classified as a tertiary amine?
Your Answer: Clomipramine
Explanation:Tricyclic Antidepressants: Uses, Types, and Side-Effects
Tricyclic antidepressants (TCAs) are a type of medication used for depression and neuropathic pain. However, due to their side-effects and toxicity in overdose, they are not commonly used for depression anymore. TCAs can be divided into two types: first generation (tertiary amines) and second generation (secondary amines). The secondary amines have a lower side effect profile and act primarily on noradrenaline, while the tertiary amines boost serotonin and noradrenaline.
Some examples of secondary amines include desipramine, nortriptyline, protriptyline, and amoxapine. Examples of tertiary amines include amitriptyline, lofepramine, imipramine, clomipramine, dosulepin (dothiepin), doxepin, trimipramine, and butriptyline. Common side-effects of TCAs include drowsiness, dry mouth, blurred vision, constipation, and urinary retention.
Low-dose amitriptyline is commonly used for neuropathic pain and prophylaxis of headache. Lofepramine has a lower incidence of toxicity in overdose. However, amitriptyline and dosulepin (dothiepin) are considered the most dangerous in overdose. It is important to consult with a healthcare provider before taking any medication and to follow their instructions carefully.
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This question is part of the following fields:
- Psychopharmacology
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Question 12
Correct
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What product has been taken off the UK market because of its impact on the QTc interval?
Your Answer: Thioridazine
Explanation:The UK market no longer offers thioridazine and droperidol due to their impact on the QTc interval.
Amantadine and QTc Prolongation
Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.
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This question is part of the following fields:
- Psychopharmacology
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Question 13
Correct
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A 42-year-old woman arrives at the emergency department complaining of sensations in her head that she describes as similar to 'electric shocks'. She has a history of anxiety and depression and has been taking venlafaxine for the past two months, but has a track record of not taking her medication regularly. Apart from that, she is in good health. Her vital signs show a slightly elevated blood pressure, and her routine blood tests and 12-lead ECG are normal. What is the probable cause of her symptoms?
Your Answer: Discontinuation symptoms
Explanation:Discontinuation symptoms are frequently observed in patients taking antidepressants with a shorter half-life, especially venlafaxine of paroxetine. These symptoms can be unsettling, and even patients who are aware of the cause may experience them for several days of longer if they do not resume taking the medication. Malignant hypertension is improbable since the blood pressure is not significantly elevated. Venlafaxine is not typically linked to neuroleptic malignant syndrome.
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This question is part of the following fields:
- Psychopharmacology
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Question 14
Correct
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You are asked to evaluate a woman on a general medical ward who has been admitted for a chest infection. The medical team suspects that she may be experiencing depression and has initiated treatment. You notice that her QTc interval measures at 490 msec and are concerned about the medications she is taking. If she were to be prescribed any of the following medications, which one would be the most likely culprit for her prolonged QTc?
Your Answer: Erythromycin
Explanation:Amantadine and QTc Prolongation
Amantadine is a medication used to treat Parkinson’s disease and influenza. It has been associated with QTc prolongation, which can increase the risk of Torsades de points. Therefore, caution should be exercised when prescribing amantadine to patients with risk factors for QT prolongation. If a patient is already taking amantadine and develops a prolonged QTc interval, the medication should be discontinued and an alternative treatment considered. It is important to monitor the QTc interval in patients taking amantadine, especially those with risk factors for QT prolongation.
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This question is part of the following fields:
- Psychopharmacology
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Question 15
Incorrect
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What is a true statement about agomelatine?
Your Answer: It should only be used where there is a significant sleep pattern dysfunction
Correct Answer: It is not associated with sexual side effects
Explanation:Agomelatine is a medication used to treat depression. It works by activating melatonin receptors (MT1 and MT2) and blocking serotonin 5-HT2C receptors.
Antidepressants can cause sexual dysfunction as a side-effect, although the rates vary. The impact on sexual desire, arousal, and orgasm can differ depending on the type of antidepressant. It is important to rule out other causes and consider non-pharmacological strategies such as reducing the dosage of taking drug holidays. If necessary, switching to a lower risk antidepressant of using pharmacological options such as phosphodiesterase inhibitors of mirtazapine augmentation can be considered. The Maudsley Guidelines 14th Edition provides a helpful table outlining the risk of sexual dysfunction for different antidepressants.
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This question is part of the following fields:
- Psychopharmacology
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Question 16
Incorrect
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What is a frequently observed side-effect of lisdexamfetamine?
Your Answer: Bruxism
Correct Answer: Decreased appetite
Explanation:ADHD medications can be classified into stimulant and non-stimulant drugs. The therapeutic effects of these drugs are believed to be mediated through the action of noradrenaline in the prefrontal cortex. Common side effects of these drugs include decreased appetite, insomnia, nervousness, headache, and nausea. Stimulant drugs like dexamphetamine, methylphenidate, and lisdexamfetamine inhibit the reuptake of dopamine and noradrenaline. Non-stimulant drugs like atomoxetine, guanfacine, and clonidine work by increasing noradrenaline levels in the synaptic cleft through different mechanisms. The most common side effects of these drugs are decreased appetite, somnolence, headache, and abdominal pain.
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This question is part of the following fields:
- Psychopharmacology
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Question 17
Correct
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Which of the following sites is not recognized for drug metabolism?
Your Answer: Bone marrow
Explanation:Understanding Biotransformation: A Metabolic Process for Excretion
Biotransformation is a metabolic process that occurs primarily in the liver, but also in other organs such as the kidneys, intestine, adipose, skin, and lungs. Its main function is to facilitate the excretion of both exogenous and endogenous substances by altering their chemical structures through a series of reactions. Enzymes found in the cytoplasm, endoplasmic reticulum, and mitochondria of cells catalyze these reactions, which can cause the substrate to become inactive, active, of even toxic.
Biotransformation is divided into three phases. Phase I reactions involve oxidation, reduction, of hydrolysis of the drug, yielding a polar, water-soluble metabolite that is often still active. Phase II reactions consist of adding hydrophilic groups to the original molecule, a toxic intermediate, of a nontoxic metabolite formed in phase I, to increase its polarity. The most common method is conjugation with glucuronic acid, but other groups such as sulphate, amino acids, acetate, and methyl can also be added. Phase III reactions occur post-phase II, where a chemical substance can undergo further metabolism and excretion through active transport into the urinary of hepatobiliary system.
Understanding biotransformation is crucial in pharmacology and toxicology, as it affects the efficacy and toxicity of drugs and other substances. By facilitating the excretion of these substances, biotransformation helps maintain homeostasis in the body and prevent accumulation of potentially harmful compounds.
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This question is part of the following fields:
- Psychopharmacology
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Question 18
Incorrect
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A teenager with schizophrenia is started on clozapine and experiences a complete response. However, they gain a considerable amount of weight and are eager to find a solution. Despite attempts to lower the dosage, relapse occurs. What medication has been proven to decrease weight when combined with clozapine?
Your Answer: Asenapine
Correct Answer: Aripiprazole
Explanation:Antipsychotic drugs are known to cause weight gain, but some more than others. The reason for this is not due to a direct metabolic effect, but rather an increase in appetite and a decrease in activity levels. The risk of weight gain appears to be linked to clinical response. There are several suggested mechanisms for this, including antagonism of certain receptors and hormones that stimulate appetite. The risk of weight gain varies among different antipsychotics, with clozapine and olanzapine having the highest risk. Management strategies for antipsychotic-induced weight gain include calorie restriction, low glycemic index diet, exercise, and switching to an alternative antipsychotic. Aripiprazole, ziprasidone, and lurasidone are recommended as alternative options. Other options include aripiprazole augmentation, metformin, orlistat, liraglutide, and topiramate.
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This question is part of the following fields:
- Psychopharmacology
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Question 19
Correct
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Which medication(s) have been associated with extrapyramidal side effects?
Your Answer: Fluoxetine
Explanation:EPSE’s have been linked to the use of fluoxetine, and all of the treatment options are utilized to address them.
Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).
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This question is part of the following fields:
- Psychopharmacology
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Question 20
Incorrect
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Which option is the least appropriate for nighttime sedation?
Your Answer: Temazepam
Correct Answer: Diazepam
Explanation:It is advisable to avoid agents with longer half lives as they have a tendency to induce drowsiness in patients.
Benzodiazepines are a class of drugs commonly used to treat anxiety and sleep disorders. It is important to have a working knowledge of the more common benzodiazepines and their half-life. Half-life refers to the amount of time it takes for half of the drug to be eliminated from the body.
Some of the more common benzodiazepines and their half-life include diazepam with a half-life of 20-100 hours, clonazepam with a half-life of 18-50 hours, chlordiazepoxide with a half-life of 5-30 hours, nitrazepam with a half-life of 15-38 hours, temazepam with a half-life of 8-22 hours, lorazepam with a half-life of 10-20 hours, alprazolam with a half-life of 10-15 hours, oxazepam with a half-life of 6-10 hours, zopiclone with a half-life of 5-6 hours, zolpidem with a half-life of 2 hours, and zaleplon with a half-life of 2 hours. Understanding the half-life of these drugs is important for determining dosages and timing of administration.
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This question is part of the following fields:
- Psychopharmacology
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Question 21
Incorrect
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Which options are typically not utilized for managing extrapyramidal side-effects?
Your Answer: Antimuscarinics
Correct Answer: Dopamine agonists
Explanation:EPSE’s result from the blocking of dopaminergic D2 receptors, so theoretically, dopamine agonists could alleviate them. However, they are not typically prescribed because they could worsen the underlying psychotic condition. Amantadine is an exception, as it is believed to work by stimulating dopamine receptors. It should be noted, however, that amantadine has complex effects and may exacerbate psychotic symptoms in certain patients.
Extrapyramidal side-effects (EPSE’s) are a group of side effects that affect voluntary motor control, commonly seen in patients taking antipsychotic drugs. EPSE’s include dystonias, parkinsonism, akathisia, and tardive dyskinesia. They can be frightening and uncomfortable, leading to problems with non-compliance and can even be life-threatening in the case of laryngeal dystonia. EPSE’s are thought to be due to antagonism of dopaminergic D2 receptors in the basal ganglia. Symptoms generally occur within the first few days of treatment, with dystonias appearing quickly, within a few hours of administration of the first dose. Newer antipsychotics tend to produce less EPSE’s, with clozapine carrying the lowest risk and haloperidol carrying the highest risk. Akathisia is the most resistant EPSE to treat. EPSE’s can also occur when antipsychotics are discontinued (withdrawal dystonia).
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This question is part of the following fields:
- Psychopharmacology
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Question 22
Incorrect
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What is the correct statement regarding adverse drug reactions (ADRs)?
Your Answer: Drug toxicity is a type of nonimmunologic reaction
Correct Answer: An ADR is a harmful outcome of a medication when used at a high dose
Explanation:ADRs only occur when medications are used at ABNORMAL doses. (FALSE)
Adverse Drug Reactions (ADRs) refer to the harmful effects associated with the use of a medication at a normal dose. These reactions are classified into two types: Type A and Type B. Type A reactions can be predicted from the pharmacology of the drug and are dose-dependent, meaning they can be reversed by withdrawing the drug. On the other hand, Type B reactions cannot be predicted from the known pharmacology of the drug and include allergic reactions.
Type A reactions account for up to 80% of all ADRs, while Type B reactions are less common. Allergic reactions are a type of Type B reaction and are further subdivided by Gell and Coombs into four types: Type I (IgE-mediated) reactions, Type II (cytotoxic) reactions, Type III (immune complex) reactions, and Type IV (cell-mediated) reactions. Proper identification and management of ADRs are crucial in ensuring patient safety and optimizing treatment outcomes.
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This question is part of the following fields:
- Psychopharmacology
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Question 23
Correct
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In what category of antipsychotics does haloperidol fall under?
Your Answer: Butyrophenone
Explanation:Antipsychotics can be classified in various ways, including by chemical structure. One common classification is into typical (first generation) and atypical (second generation) antipsychotics. Haloperidol is a butyrophenone, while other antipsychotics fall into categories such as benzoxazoles (risperidone), dibenzodiazapines (clozapine), dibenzothiazapines (quetiapine), and Thienobenzodiazepine (olanzapine). Phenothiazines are another structural classification, with three groups: aliphatic compounds (chlorpromazine, promazine, methotrimeprazine), piperazines (trifluoperazine, fluphenazine, perphenazine), and piperidines (thioridazine, pipothiazine). Other structural categories include thioxanthenes (flupentixol, zuclopenthixol), diphenylbutylpiperidine (pimozide), substituted benzamides (sulpiride, amisulpride), and arylpiperidylindole (quinolone) such as aripiprazole.
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This question is part of the following fields:
- Psychopharmacology
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Question 24
Incorrect
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When is the optimal time to collect blood samples for monitoring therapeutic lithium levels?
Your Answer: 6 hours after last dose
Correct Answer: 12 hours after last dose
Explanation:Lithium – Pharmacology
Pharmacokinetics:
Lithium salts are rapidly absorbed following oral administration and are almost exclusively excreted by the kidneys unchanged. Blood samples for lithium should be taken 12 hours post-dose.Ebstein’s:
Ebstein’s anomaly is a congenital malformation consisting of a prolapse of the tricuspid valve into the right ventricle. It occurs in 1:20,000 of the general population. Initial data suggested it was more common in those using lithium but this had not held to be true.Contraindications:
Addison’s disease, Brugada syndrome, cardiac disease associated with rhythm disorders, clinically significant renal impairment, untreated of untreatable hypothyroidism, low sodium levels.Side-effects:
Common side effects include nausea, tremor, polyuria/polydipsia, rash/dermatitis, blurred vision, dizziness, decreased appetite, drowsiness, metallic taste, and diarrhea. Side-effects are often dose-related.Long-term use is associated with hypothyroidism, hyperthyroidism, hypercalcemia/hyperparathyroidism, irreversible nephrogenic diabetes insipidus, and reduced GFR.
Lithium-induced diabetes insipidus:
Treatment options include stopping lithium (if feasible), keeping levels within 0.4-0.8 mmol/L, once-daily dose of the drug taken at bedtime, amiloride, thiazide diuretics, indomethacin, and desmopressin.Toxicity:
Lithium salts have a narrow therapeutic/toxic ratio. Risk factors for lithium toxicity include drugs altering renal function, decreased circulating volume, infections, fever, decreased oral intake of water, renal insufficiency, and nephrogenic diabetes insipidus. Features of lithium toxicity include GI symptoms and neuro symptoms.Pre-prescribing:
Before prescribing lithium, renal function, cardiac function, thyroid function, FBC, and BMI should be checked. Women of childbearing age should be advised regarding contraception, and information about toxicity should be provided.Monitoring:
Lithium blood levels should be checked weekly until stable, and then every 3-6 months once stable. Thyroid and renal function should be checked every 6 months. Patients should be issued with an information booklet, alert card, and record book. -
This question is part of the following fields:
- Psychopharmacology
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Question 25
Incorrect
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A drug that has a constant elimination rate regardless of its concentration exhibits what characteristic?
Your Answer: Third order kinetics
Correct Answer: Zero order kinetics
Explanation:The half-life of a drug is the time taken for its concentration to fall to one half of its value. Drugs with long half-lives may require a loading dose to achieve therapeutic plasma concentrations rapidly. It takes about 4.5 half-lives to reach steady state plasma levels. Most drugs follow first order kinetics, where a constant fraction of the drug in the body is eliminated per unit time. However, some drugs may follow zero order kinetics, where the plasma concentration of the drug decreases at a constant rate, despite the concentration of the drug. For drugs with nonlinear kinetics of dose-dependent kinetics, the relationship between the AUC of CSS and dose is not linear, and the kinetic parameters may vary depending on the administered dose.
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This question is part of the following fields:
- Psychopharmacology
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Question 26
Incorrect
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Antipsychotic drugs are known to cause hypotension, and it is believed that this effect is mediated by a specific type of receptor. Which receptor is thought to be responsible for this?
Your Answer: D2
Correct Answer: Alpha 1
Explanation:Postural hypotension is a known side effect of alpha-1-blockade.
Antipsychotics: Common Side Effects and Relative Adverse Effects
Antipsychotics are medications used to treat various mental health conditions, including schizophrenia and bipolar disorder. However, they can also cause side effects that can be bothersome of even serious. The most common side effects of antipsychotics are listed in the table below, which includes the adverse effects associated with their receptor activity.
Antidopaminergic effects: These effects are related to the medication’s ability to block dopamine receptors in the brain. They can cause galactorrhoea, gynecomastia, menstrual disturbance, lowered sperm count, reduced libido, Parkinsonism, dystonia, akathisia, and tardive dyskinesia.
Anticholinergic effects: These effects are related to the medication’s ability to block acetylcholine receptors in the brain. They can cause dry mouth, blurred vision, urinary retention, and constipation.
Antiadrenergic effects: These effects are related to the medication’s ability to block adrenaline receptors in the body. They can cause postural hypotension and ejaculatory failure.
Histaminergic effects: These effects are related to the medication’s ability to block histamine receptors in the brain. They can cause drowsiness.
The Maudsley Guidelines provide a rough guide to the relative adverse effects of different antipsychotics. The table below summarizes their findings, with +++ indicating a high incidence of adverse effects, ++ indicating a moderate incidence, + indicating a low incidence, and – indicating a very low incidence.
Drug Sedation Weight gain Diabetes EPSE Anticholinergic Postural Hypotension Prolactin elevation
Amisulpride – + + + – – +++
Aripiprazole – +/- – +/- – – –
Asenapine + + +/- +/- – – +/-
Clozapine +++ +++ +++ – +++ +++ –
Flupentixol + ++ + ++ ++ + +++
Fluphenazine + + + +++ ++ + +++
Haloperidol + + +/- +++ + + +++
Olanzapine ++ +++ +++ +/- + + +
Paliperidone + ++ + + + ++ +++
Pimozide + + – + + + +++
Quetiapine ++ ++ ++ – + ++ –
Risperidone + ++ + + + ++ +++
Zuclopenthixol ++ ++ + ++ ++ + +++Overall, it is important to discuss the potential side effects of antipsychotics with a healthcare provider and to monitor for any adverse effects while taking these medications.
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This question is part of the following fields:
- Psychopharmacology
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Question 27
Incorrect
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What is a true statement about flumazenil?
Your Answer: It has a half life of 15 hours
Correct Answer: Flumazenil is not currently licensed for the treatment of benzodiazepine overdose in the UK
Explanation:Flumazenil is not authorized for treating benzodiazepine overdose in the UK, despite its widespread use. It works by competitively inhibiting the benzodiazepine binding site on the GABAA receptor, reversing the effects of benzodiazepines. Due to its short half-life of 60 minutes, it is important to note that multiple doses may be necessary in cases of benzodiazepine overdose.
Flumazenil: A Selective GABAA Receptor Antagonist
Flumazenil is a medication that selectively blocks the effects of benzodiazepines on the GABAA receptor. It is used to reverse the sedative effects caused by benzodiazepines, either partially or completely. Flumazenil works by competitively interacting with benzodiazepine receptors, which can reverse the binding of benzodiazepines to these receptors. It is administered intravenously and has a short half-life of about 60 minutes. The effects of flumazenil are usually shorter than those of benzodiazepines, and sedation may recur. Flumazenil also blocks non-benzodiazepine-agonists like zopiclone. However, it has no effect on other drugs such as barbiturates, ethanol, of other GABA-mimetic agents unless they act on the benzodiazepine receptor site. The hypnosedative effects of benzodiazepines are rapidly blocked within 1-2 minutes after intravenous administration, and the duration of action ranges from 20 to 50 minutes.
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This question is part of the following fields:
- Psychopharmacology
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Question 28
Correct
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Which statement about modafinil is accurate?
Your Answer: It does not tend to lead to dependence
Explanation:Modafinil shares similarities in its mechanism of action with amphetamine, and its effects are relatively brief with a half-life of approximately 8-12 hours. Additionally, the side effects of modafinil are comparable to those of amphetamine.
Modafinil: A Psychostimulant for Wakefulness and Attention Enhancement
Modafinil is a type of psychostimulant that is known to improve wakefulness, attention, and vigilance. Although it is similar to amphetamines, it does not produce the same euphoric effects and is not associated with dependence of tolerance. Additionally, it does not seem to cause psychosis. Modafinil is approved for the treatment of narcolepsy, obstructive sleep apnea, and chronic shift work. It is also suggested as an adjunctive treatment for depression by the Maudsley. Recently, it has gained popularity as a smart drug due to its potential to enhance cognitive functioning in healthy individuals.
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This question is part of the following fields:
- Psychopharmacology
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Question 29
Incorrect
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Which drug does not belong to the category of NMDA antagonists?
Your Answer: Phencyclidine
Correct Answer: Rivastigmine
Explanation:Rivastigmine inhibits cholinesterase in a reversible manner.
Mechanisms of Action of Different Drugs
Understanding the mechanisms of action of different drugs is crucial for medical professionals. It is a common topic in exams and can earn easy marks if studied well. This article provides a list of drugs and their mechanisms of action in different categories such as antidepressants, anti dementia drugs, mood stabilizers, anxiolytic/hypnotic drugs, antipsychotics, drugs of abuse, and other drugs. For example, mirtazapine is a noradrenaline and serotonin specific antidepressant that works as a 5HT2 antagonist, 5HT3 antagonist, H1 antagonist, alpha 1 and alpha 2 antagonist, and moderate muscarinic antagonist. Similarly, donepezil is a reversible acetylcholinesterase inhibitor used as an anti dementia drug, while valproate is a GABA agonist and NMDA antagonist used as a mood stabilizer. The article also explains the mechanisms of action of drugs such as ketamine, phencyclidine, buprenorphine, naloxone, atomoxetine, varenicline, disulfiram, acamprosate, and sildenafil.
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This question is part of the following fields:
- Psychopharmacology
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Question 30
Incorrect
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A teenage male patient with a first episode of schizophrenia is interested in discussing long-term treatment options. He expresses concern about potential sexual side-effects and states that he would discontinue therapy if they were to occur. What would be the most appropriate course of action in this scenario?
Your Answer:
Correct Answer: Aripiprazole
Explanation:Antipsychotics and Sexual Dysfunction: Causes, Risks, and Management
Sexual dysfunction is a common side effect of antipsychotic medication, with the highest risk associated with risperidone and haloperidol due to their effect on prolactin levels. Clozapine, olanzapine, quetiapine, aripiprazole, asenapine, and lurasidone are associated with lower rates of sexual dysfunction. The Arizona Sexual Experiences Scale (ASEX) can be used to measure sexual dysfunction before and during treatment. Management options include excluding other causes, watchful waiting, dose reduction, switching to a lower risk agent, adding aripiprazole, considering an antidote medication, of using sildenafil for erectile dysfunction. It is important to address sexual dysfunction to improve quality of life and medication adherence.
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This question is part of the following fields:
- Psychopharmacology
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